Individual provider Active NPI

Susan H Tannenbaum, MD

  • Hematology & Oncology Physician
  • Farmington, CT
National Provider Identifier
1447257704
Registry record updated Sep 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
041311 Issued in CT
Practice address
263 Farmington Ave
Farmington, CT 06030-0001
Phone
(860) 679-2100
Fax
(860) 679-4815
NPI assigned
Jul 1, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X 041311 CT Primary

Addresses

Primary practice location

263 Farmington Ave
Farmington, CT 06030-0001

Mailing address

65 Kane St
West Hartford, CT 06119-2110
Phone (860) 523-6421

Other identifiers 1

IdentifierTypeStateIssuer
1413111MedicaidCT

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address stannenbaum11025@direct.med.uchc.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100203000423 CT Practitioner - Hematology/OncologyPractitioner - Internal MedicinePractitioner - Medical Oncology 1355484056 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
University of Connecticut Health Center Hematology & Oncology CurrentSince Jul 1, 2003 Accepting new patients
University of Connecticut Health Center CurrentSince Jul 1, 2003 Accepting new patients
University of Connecticut Health Center Past Accepting new patients

Locations

263 Farmington Ave
Farmington, CT 06030
Phone (860) 679-4477

65 Kane St
West Hartfrd, CT 06119
Phone (860) 523-6421

Interoperability endpoints

  • Direct secure messaging: stannenbaum11025@direct.med.uchc.edu

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664150400000",
    "number": "1447257704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 KANE ST",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061192110",
            "telephone_number": "860-523-6421",
            "fax_number": "860-523-3701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "263 FARMINGTON AVE",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060300001",
            "telephone_number": "860-679-2100",
            "fax_number": "860-679-4815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANNENBAUM",
        "first_name": "SUSAN",
        "middle_name": "H",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-01",
        "last_updated": "2022-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "CT",
            "license": "041311",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1413111",
            "state": "CT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "stannenbaum11025@direct.med.uchc.edu",
            "affiliation": "N",
            "address_1": "Uconn Medical Group",
            "address_2": "263 Farmington Avenue",
            "city": "Farmington",
            "state": "CT",
            "country_code": "US",
            "postal_code": "060300001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Farmington, CT

Sources for this page

Verify at the official NPI Registry.